Health Care For America Now

At the afternoon panel at the Families USA Health Action 2009 conference, representatives from some of the most powerful committees on Capital Hill with respect to health care reform, the House Energy and Commerce Committee, the Senate Finance Committee, and the Health, Education, Labor, and Pension Committee had and extended discussion about health care reform. Here are the highlights from Yvette Fontenot (Finance), John McDonough (HELP), and Karen Nelson (Energy and Commerce).

On how to expand coverage:

Yvette: Baucus put out a white paper that lays out his vision. Organize the individual market using an exchange like the Massachusetts Connector. Have a public option and private plans, all using a certain set of rules, standardized marketing, enrollment, and rating rules. The market is in dire need of some standard rules. And have a new program focusing specifically on prevention.

Karen: Our #1 goal is to get coverage to everybody through an amalgamation of private and public systems. [Chairman] Henry Waxman's view is the public component is a very important component, and we think it'll make the private system better. He does believe we get a lot of value out of the employer's role of providing health insurance to people; we would be reluctant to give that up.

John: If you think about the key players in the House and Senate and White House, I don't think you'll see such consensus and consistency from all of the key players as you see right now. If you think back to 93, when Daniel Patrick Moynahan, then Chairman of the Senate Finance Committee, was openly contemptible of health care reform, contrasted with where Max Baucus is now.

This effort starts with coverage for every American. Delivery system reform is 2nd, addressing quality and cost and providing better value. 3rd, focusing the system on prevention and wellness. Lastly is financing, particularly how we'll pay for coverage, which is the most expensive piece. There must be fundamental, deep systemic private insurance market reform, eliminating horrific practices. It goes from there into some kind of individual responsibility in line with employer responsibility. And create a fairly massive subsidy structure to make purchasing insurance affordable to all Americans.

On public insurance programs:

Karen: Everyone would have the potential to look at the public program. You just don't get private insurance that covers Medicaid/Medicare style needs.

John: Nobody is talking about eroding or cutting back or pushing down on what we currently do [with SCHIP, Medicare, and Medicaid]. But there is a broad opinion that we have to move towards a national standard for everyone for Medicaid, and not have categorical differences between parents and kids.

Yvette: The other function of the public programs is playing a vital role in improving the value of the care we're getting. Improvements can seep into the private sector if they're driven through the public programs.

This concept of the public health insurance option that would be part of the exchange as we envision it. There are several reasons that's important. One, we don't know if this exchange market is really going to emerge, so some kind of safety net is necessary. Second, for special needs populations a public insurance option could care for them better. And finally, public programs simply have lower administrative costs than private insurance. The hope is with the public program competing with private programs, costs are driven down for the entire population.

On how we pay for health care and PAYGO:

Yvette: We included several proposals that generated savings in the white paper. Our intention is to not spend anymore over 10 years than we're currently expected to spend, but to do it more effectively and cover everyone. But, health care reform will require an upfront investment. We have to show over 10 years that we're bending the cost growth curve. We can't have a sustainable economy if we don't contain health care costs. But we need to invest early and spend to save over the long term. We need to get out of this PAYGO year-by-year mentality, and look at national health expenditures and what we can do in the next 5, 10, 20 years to bend our costs and get everyone covered.

Karen: If we stick with PAYGO we can't do it. At least we can't look year by year, a longer timeframe is needed. Lots of education needed to Members of Congress.

John: We are all very cognizant of issues of finances. We need to create a shared, societal understanding on how we'll pay for this. The other piece is Presidential leadership and political will. That's the z-factor in this whole equation, how much of a game changer will the new administration be. Not so much in policy, but being able to summon a sense of national purpose, that the goal is so much more important than any individual group's grievances.

On timing of the new health care bill:

John: Ideal timing would be very quickly right after stimulus. There are lots of issues we have to work through, though. We are committed to moving this as quickly as possible. Kennedy, this is his #1 issue. But we'll have to take a little pause to leave the administration time to find its footing and weigh in in a robust way.

Karen: We have a keen awareness that we have to do this rapidly, just the way the politics works. Every committee chairman wants to move rapidly. We obviously can't pass something too simple, but we can't get bogged down in details, that we feel we have to solve every single problem the first step out, which was one of the criticisms of the Clinton plan. Daschle in his book was clear in this, a happy medium is needed

I'll be back tomorrow with more!